Skip to main content

Advertisement

SpringerLink
Log in

Retrospective study on the potential of albumin/globulin ratio as a prognostic biomarker for oral cavity cancer patients

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Although the serum albumin/globulin ratio (AGR) is recognized as a valuable prognostic biomarker in various cancers, its clinical value in oral cavity squamous cell carcinoma (OSCC) is still unclear. We aimed to probe the prognostic value of AGR in patients with OSCC undergoing curative surgery.

Methods

This retrospective study analyzed 306 patients who were newly diagnosed as having OSCC and receiving curative surgery between 2008 and 2017. The correlation of AGR with survival outcomes was estimated using Cox proportional hazards models and Kaplan–Meier analysis. A nomogram based on AGR was established, and its accuracy was assessed according to the concordance index.

Results

The log rank test and Kaplan–Meier analysis indicated that patients who had low AGR had significantly shorter disease-free survival (DFS) as well as 5-year overall survival (OS) than those with high AGR. The multivariate Cox analysis revealed that low AGR was an independent predictor of poor OS and DFS (adjusted hazard ratio [aHR] = 2.812; 95% CI 1.729–4.573; p < 0.001, and aHR = 1.743; 95% CI 1.201–2.530; p = 0.003, respectively). The concordance index of the nomogram model based on TNM staging alone was 0.656 and could increase to 0.783 with the inclusion of AGR and other prognostic variables in the calculation.

Conclusion

Preoperative AGR may represent an accessible, valuable prognostic biomarker in patients with OSCC. The nomogram model incorporating AGR and clinicopathological prognostic variables may improve the accuracy of prognostic predictions in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

Data sets used and analyzed can be provided by the corresponding author upon reasonable request.

References

  1. Rivera C (2015) Essentials of oral cancer. Int J Clin Exp Pathol 8:11884–11894

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Health Promotion Administration MOHaW, Taiwan (2016) Cancer Registry Annual Report 2016

  3. Kao SY, Lim E (2015) An overview of detection and screening of oral cancer in Taiwan. Chin J Dent Res 18:7–12

    PubMed  Google Scholar 

  4. Omura K (2014) Current status of oral cancer treatment strategies: surgical treatments for oral squamous cell carcinoma. Int J Clin Oncol 19:423–430

    Article  CAS  Google Scholar 

  5. Ettinger KS, Ganry L, Fernandes RP (2019) Oral cavity cancer. Oral Maxillofac Surg Clin North Am 31:13–29

    Article  Google Scholar 

  6. Scully C, Moles DR (2008) Oral Cancer. In: Heggenhougen HK (ed) International encyclopedia of public health. Academic Press, Oxford, pp 668–677

    Chapter  Google Scholar 

  7. Liao C-T, Lin C-Y, Fan K-H et al (2015) The optimal treatment modality for taiwan oral cavity cancer patients-experience of a medical center. J Cancer Res Pract 2:103–116

    Google Scholar 

  8. Chinn SB, Myers JN (2015) Oral cavity carcinoma: current management, controversies, and future directions. J Clin Oncol 33:3269–3276

    Article  CAS  Google Scholar 

  9. Eltohami YI, Kao HK, Lao WW et al (2018) The prediction value of the systemic inflammation score for oral cavity squamous cell carcinoma. Otolaryngol Head Neck Surg 158:1042–1050

    Article  Google Scholar 

  10. Sobin LH (2003) TNM: evolution and relation to other prognostic factors. Semin Surg Oncol 21:3–7

    Article  Google Scholar 

  11. Rivera C, Oliveira AK, RaP C et al (2017) Prognostic biomarkers in oral squamous cell carcinoma: a systematic review. Oral Oncol 72:38–47

    Article  CAS  Google Scholar 

  12. Lim WS, Roh JL, Kim SB et al (2017) Pretreatment albumin level predicts survival in head and neck squamous cell carcinoma. Laryngoscope 127:E437–E442

    Article  CAS  Google Scholar 

  13. Moon H, Roh JL, Lee SW et al (2016) Prognostic value of nutritional and hematologic markers in head and neck squamous cell carcinoma treated by chemoradiotherapy. Radiother Oncol 118:330–334

    Article  Google Scholar 

  14. Tampa M, Mitran MI, Mitran CI et al (2018) Mediators of inflammation—a potential source of biomarkers in oral squamous cell carcinoma. J Immunol Res 2018:1061780

    Article  Google Scholar 

  15. Deng T, Lyon CJ, Bergin S et al (2016) Obesity, inflammation, and cancer. Annu Rev Pathol 11:421–449

    Article  CAS  Google Scholar 

  16. Mcmillan DC (2009) Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care 12:223–226

    Article  Google Scholar 

  17. Zhou T, Yu ST, Chen WZ et al (2019) Pretreatment albumin globulin ratio has a superior prognostic value in laryngeal squamous cell carcinoma patients: a comparison study. J Cancer 10:594–601

    Article  CAS  Google Scholar 

  18. Mcmillan DC, Watson WS, O’gorman P et al (2001) Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer 39:210–213

    Article  CAS  Google Scholar 

  19. Tsai MH, Chuang HC, Lin YT et al (2018) Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction-a retrospective study. PeerJ 6:e4490

    Article  Google Scholar 

  20. Oki S, Toiyama Y, Okugawa Y et al (2017) Clinical burden of preoperative albumin-globulin ratio in esophageal cancer patients. Am J Surg 214:891–898

    Article  Google Scholar 

  21. Hachiya H, Ishizuka M, Takagi K et al (2018) Clinical significance of the globulin-to-albumin ratio for prediction of postoperative survival in patients with colorectal cancer. Ann Gastroenterol Surg 2:434–441

    Article  Google Scholar 

  22. Zhou T, He X, Fang W et al (2016) Pretreatment albumin/globulin ratio predicts the prognosis for small-cell lung cancer. Medicine (Baltimore) 95:e3097

    Article  CAS  Google Scholar 

  23. Du XJ, Tang LL, Mao YP et al (2014) The pretreatment albumin to globulin ratio has predictive value for long-term mortality in nasopharyngeal carcinoma. PLoS ONE 9:e94473

    Article  Google Scholar 

  24. He X, Guo S, Chen D et al (2017) Preoperative albumin to globulin ratio (AGR) as prognostic factor in renal cell carcinoma. J Cancer 8:258–265

    Article  CAS  Google Scholar 

  25. Deng Y, Pang Q, Miao RC et al (2016) Prognostic significance of pretreatment albumin/globulin ratio in patients with hepatocellular carcinoma. Onco Targets Ther 9:5317–5328

    Article  CAS  Google Scholar 

  26. Azab BN, Bhatt VR, Vonfrolio S et al (2013) Value of the pretreatment albumin to globulin ratio in predicting long-term mortality in breast cancer patients. Am J Surg 206:764–770

    Article  CAS  Google Scholar 

  27. Jariod-Ferrer UM, Arbones-Mainar JM, Gavin-Clavero MA et al (2019) Are comorbidities associated with overall survival in patients with oral squamous cell carcinoma? J Oral Maxillofac Surg 77:1906–1914

    Article  Google Scholar 

  28. Lazennec G, Richmond A (2010) Chemokines and chemokine receptors: new insights into cancer-related inflammation. Trends Mol Med 16:133–144

    Article  CAS  Google Scholar 

  29. Toiyama Y, Yasuda H, Ohi M et al (2017) Clinical impact of preoperative albumin to globulin ratio in gastric cancer patients with curative intent. Am J Surg 213:120–126

    Article  Google Scholar 

  30. Suh B, Park S, Shin DW et al (2014) Low albumin-to-globulin ratio associated with cancer incidence and mortality in generally healthy adults. Ann Oncol 25:2260–2266

    Article  CAS  Google Scholar 

  31. Lv GY, An L, Sun XD et al (2018) Pretreatment albumin to globulin ratio can serve as a prognostic marker in human cancers: a meta-analysis. Clin Chim Acta 476:81–91

    Article  CAS  Google Scholar 

  32. Van Bokhorst-De Van Der S, Van Leeuwen PA, Kuik DJ et al (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86:519–527

    Article  Google Scholar 

  33. Liu J, Dai Y, Zhou F et al (2016) The prognostic role of preoperative serum albumin/globulin ratio in patients with bladder urothelial carcinoma undergoing radical cystectomy. Urol Oncol 34(484):e481–484 (e488)

    Google Scholar 

  34. Laky B, Janda M, Cleghorn G et al (2008) Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr 87:1678–1685

    Article  CAS  Google Scholar 

  35. Chen WZ, Yu ST, Xie R et al (2017) Preoperative albumin/globulin ratio has predictive value for patients with laryngeal squamous cell carcinoma. Oncotarget 8:48240–48247

    Article  Google Scholar 

  36. Gabay C, Kushner I (1999) Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 340:448–454

    Article  CAS  Google Scholar 

  37. Vinzenz K, Pavelka R, Schonthal E et al (1986) Serum immunoglobulin levels in patients with head and neck cancer (IgE, IgA, IgM, IgG). Oncology 43:316–322

    Article  CAS  Google Scholar 

  38. Chi J, Xie Q, Jia J et al (2018) Prognostic value of albumin/globulin ratio in survival and lymph node metastasis in patients with cancer: a systematic review and meta-analysis. J Cancer 9:2341–2348

    Article  Google Scholar 

  39. Gundog M, Basaran H (2019) Pretreatment low prognostic nutritional index and low albumin-globulin ratio are predictive for overall survival in nasopharyngeal cancer. Eur Arch Otorhinolaryngol 276:3221–3230

    Article  Google Scholar 

  40. Montero PH, Yu C, Palmer FL et al (2014) Nomograms for preoperative prediction of prognosis in patients with oral cavity squamous cell carcinoma. Cancer 120:214–221

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful for the invaluable support provided by members of the HIE lab, Chang Gung Memorial Hospital.

Funding

This study received a grant (CMRPG6G0342) from Chang Gung Memorial Hospital, Taiwan.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzi City, Chiayi, 61363, Taiwan

    Yun-Ting Wang, Cheng-Ming Hsu, Geng-He Chang, Ming-Shao Tsai, Ethan I. Huang & Yao-Te Tsai

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

    Ku-Hao Fang

  3. Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Chia-Hsuan Lai

  4. Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

    Yi-Chan Lee

Authors
  1. Yun-Ting Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ku-Hao Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheng-Ming Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Geng-He Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chia-Hsuan Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yi-Chan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ming-Shao Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ethan I. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yao-Te Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yao-Te Tsai.

Ethics declarations

Conflict of interest

All authors have no competing interests to declare.

Ethical approval

This study obtained approval from Chang Gung Memorial Hospital’s Institutional Review Board (201901763B0).

Informed consent

The Chang Gung Memorial Hospital’s Institutional Review Board waived the necessity of receiving patients’ informed consent due to the use of anonymous data. The Chang Gung Memorial Hospital’s Institutional Review Board waived the necessity of receiving patients’ informed consent due to the use of anonymous data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, YT., Fang, KH., Hsu, CM. et al. Retrospective study on the potential of albumin/globulin ratio as a prognostic biomarker for oral cavity cancer patients. Eur Arch Otorhinolaryngol 278, 227–238 (2021). https://doi.org/10.1007/s00405-020-06145-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-06145-x

Keywords

Search

Navigation